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The Epidemiology of Tuberculosis Among Foreign-Born Persons in Minnesota, 2004-2008This slide series provides detailed epidemiologic data on demographic and clinical characteristics of cases of tuberculosis disease reported among foreign-born persons in Minnesota during the past 5 years. Available in Web, PDF, and PowerPoint formats. On this page The Epidemiology of Tuberculosis Among Foreign-Born Persons in Minnesota, 2004-2008
Slide 1: The Epidemiology of Tuberculosis Among Foreign-Born Persons in Minnesota, 2004-2008
Slide 1: The Epidemiology of Tuberculosis Among Foreign-Born Persons in Minnesota, 2004-2008. The purpose of this slide set is to characterize the epidemiology of tuberculosis (TB) disease reported among foreign-born persons in Minnesota. The slides present data in tabular and graphic formats that describe both demographic and clinical characteristics of foreign-born TB case-patients and demonstrate how these characteristics differ between foreign-born and U.S.-born patients. The data in these slides pertain to cases of active TB disease reported from 2004 through 2008. In accordance with the Minnesota Communicable Disease Reporting Rule, physicians, laboratories, and other health care providers are required to report all confirmed and suspected cases of TB disease among persons residing in Minnesota to the Minnesota Department of Health; such reports serve as the source of information for the data presented in these slides. Slide 2: Number of Tuberculosis Cases by Place of Birth, Minnesota, 1999-2008
Slide 2: Number of Tuberculosis Cases by Place of Birth, Minnesota, 1999-2008. While the number of cases of TB disease reported in the United States has declined each year since 1993, the incidence of TB disease in Minnesota has been variable during the decade from 1999 through 2008, as depicted in this slide. The total number of TB cases reported in Minnesota during 2008 was similar to that in 1999. Between 1999 and 2008, however, the annual number of TB cases peaked in 2001 (239 cases) and again in 2007 (238 cases). Most notably, while the number of TB cases reported among foreign-born persons in Minnesota during 2008 was essentially the same (i.e., one fewer case) as that in 1999, the number of cases reported among U.S.–born persons increased between those endpoints. In particular, from 2007 to 2008, the number of TB cases reported among foreign-born persons statewide decreased 24%, while the number of cases reported among U.S.-born persons increased 60%. Slide 3: Percentage of Tuberculosis Cases Born Outside the U.S., Minnesota, 1999-2008
Slide 3: Percentage of Tuberculosis Cases Born Outside the U.S., Minnesota, 1999-2008. The most distinguishing characteristic of the epidemiology of TB disease in Minnesota is the very high percentage of cases that occur among persons born outside the United States. During the decade from 1999 through 2008, the annual percentage of foreign-born persons among TB cases reported in Minnesota ranged from 73% in 2008 to 87% in 2005 and averaged 81%. In particular, the percentage of foreign-born TB case-patients decreased 14% from 85% in 2007 to 73% in 2008. This decrease can be attributed to three outbreaks that occurred among primarily U.S.-born individuals in 2008, an increase in the number of pediatric cases, and the slowing of refugees into Minnesota. In contrast, 59% of TB cases reported in the U.S. during 2008 occurred among persons born outside this country. Slide 4: Tuberculosis Cases by Age Group and Place of Birth, Minnesota, 2004-2008
Slide 4: Tuberculosis Cases by Age Group and Place of Birth, Minnesota, 2004-2008. The age distribution of TB case-patients reported in Minnesota differs markedly between U.S.-born and foreign-born patients. The majority (70%) of foreign-born TB case-patients reported in Minnesota from 2004 to 2008 were 15 to 44 years of age, whereas persons 45 years of age or older constituted 45% of U.S.-born TB case-patients. These strikingly different age distributions reflect the differing risks of exposure to TB among these populations. For example, just over half of newly-arrived immigrants with Class B TB designation and refugees that arrived in Minnesota during this 5 year period are young adults; TB case-patients of this age likely were infected with TB in their countries of origin prior to being diagnosed with active TB disease in Minnesota. Among U.S.-born persons, adults who were alive 50 or more years ago, when TB was much more prevalent in Minnesota than during more recent decades, are much more likely than younger U.S.-born persons to have been infected with TB. As these older U.S.-born persons age and develop other medical conditions that may weaken their immune systems, they may progress from remotely acquired latent TB infection to active TB disease. The proportion of children less than 5 years of age was much larger among U.S.-born TB case-patients reported in Minnesota from 2004 through 2008 than among foreign-born case-patients (18% versus 1%, respectively). Approximately 75% of these young U.S.-born pediatric case-patients were attributed to children born in the U.S. to foreign-born parents. These first-generation U.S.-born children appear to experience an increased risk of TB disease that more closely resembles that of foreign-born persons. Presumably, these children may have been exposed to TB as a result of travel to their parents' country of origin and/or visiting or recently-arrived family members who may be at increased risk for TB acquired overseas. Slide 5: Tuberculosis Cases by Race/Ethnicity and Place of Birth, Minnesota, 2004-2008
Slide 5: Tuberculosis Cases by Race/Ethnicity and Place of Birth, Minnesota, 2004-2008. The racial and ethnic distribution of TB case-patients reported in Minnesota from 2004 through 2008 differed markedly between foreign-born and U.S.-born populations. Among foreign-born TB case-patients, the majority (61%) were black, 26% were Asian, 11% were Hispanic or Latino, and 2% were white. In contrast, among U.S.-born TB case-patients, the largest proportion (37%) were white, 28% were black, 14% were Hispanic or Latino, 13% were American Indian, 7% were Asian, and 1% were multi-racial. Regardless of place of birth, however, non-white racial and ethnic populations were disproportionately affected by TB, comprising larger proportions among TB case-patients than their proportional representation in the state's population overall. Slide 6: Tuberculosis Cases by Sex and Place of Birth, Minnesota, 2004-2008
Slide 6: Tuberculosis Cases by Sex and Place of Birth, Minnesota, 2004-2008. This slide presents TB cases, by sex, reported in Minnesota from 2004 through 2008. These data demonstrate that slightly more males than females were represented among TB cases reported statewide, which is typical of TB cases reported in the United States. The preponderance of males versus females, however, was markedly pronounced among U.S.-born TB cases (62% versus 38%, respectively) but barely evident and not significant among foreign-born cases (51% versus 49%, respectively). Slide 7: Foreign-Born Tuberculosis Cases by Region of Birth and Year of Diagnosis, Minnesota, 2004-2008
Slide 7: Foreign-Born Tuberculosis Cases by Region of Birth and Year of Diagnosis, Minnesota, 2004-2008. South/Southeast Asia, sub-Saharan Africa, etc. The trends visible in this slide are influenced by both the global incidence of TB in specific regions worldwide and also by the constantly changing trends and demographics of immigration to Minnesota. For example, Minnesota is home to a large population of persons born in South/Southeast Asia (including the Hmong population), which is a region of the world where TB is highly prevalent. However, prior to the arrival of a large number of Hmong refugees from a refugee camp in Thailand during the past 2 to 3 years, few new immigrants or refugees have arrived in Minnesota from South/Southeast Asia during the past 5 years. Consequently, the annual numbers of TB cases reported among this population have been moderately high but relatively stable from 2004 through 2008. The number of new immigrants and refugees who arrived in Minnesota from sub-Saharan Africa (which is another area where TB is very common), was high during each of the past 5 years. The significant recent immigration from sub-Saharan Africa is reflected in the very large numbers of TB cases reported among foreign-born persons from sub-Saharan Africa in Minnesota from 2004 through 2008.  Slide 8: Foreign-Born Tuberculosis Cases by Region of Birth, Minnesota, 2004-2008 NOTE: THIS SLIDE PRESENTS THE SAME DATA AS SLIDE 7, BUT IN TABULAR FORMAT.
Slide 8: Foreign-Born Tuberculosis Cases by Region of Birth, Minnesota, 2004-2008 (in tabular format). This slide depicts the number of TB cases reported in Minnesota from 2004 through 2008 by region of birth and year of diagnosis. The different colors represent the year of diagnosis. The bars representing the number of TB cases are grouped by region of birth — for example, South/Southeast Asia, sub-Saharan Africa, etc. The trends visible in this slide are influenced by both the global incidence of TB in specific regions worldwide and also by the constantly changing trends and demographics of immigration to Minnesota. For example, Minnesota is home to a large population of persons born in South/Southeast Asia (including the Hmong population), which is a region of the world where TB is highly prevalent. However, prior to the arrival of a large number of Hmong refugees from a refugee camp in Thailand during the past 2 to 3 years, few new immigrants or refugees have arrived in Minnesota from South/Southeast Asia during the past 5 years. Consequently, the annual numbers of TB cases reported among this population have been moderately high but relatively stable from 2004 through 2008. The number of new immigrants and refugees who arrived in Minnesota from sub-Saharan Africa (which is another area where TB is very common), was high during each of the past 5 years. The significant recent immigration from sub-Saharan Africa is reflected in the very large numbers of TB cases reported among foreign-born persons from sub-Saharan Africa in Minnesota from 2004 through 2008. Slide 9: Foreign-Born Tuberculosis Cases by Country of Birth, Minnesota, 2004-2008
Slide 9: Foreign-Born Tuberculosis Cases by Country of Birth, Minnesota, 2004-2008. Among foreign-born TB case-patients reported in Minnesota from 2004 through 2008, the largest percentage (35%) were born in Somalia. Other countries of birth that represented at least 4% of case-patients each included Ethiopia, Mexico, Vietnam, Laos, Liberia, India and Kenya. Patients from a geographically and ethnically diverse group of 52 other countries composed the remaining 22% of foreign-born TB cases reported during this period. The tremendous ethnic diversity among foreign-born TB case-patients in Minnesota poses significant challenges for providing TB prevention, treatment, and control services that are appropriate for persons from a wide array of cultural, linguistic, and socio-economic backgrounds. Slide 10: Black Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008
Slide 10: Black Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008. As previous slides demonstrate, country of birth is the predominant risk factor for TB disease in Minnesota. Also, independent of country of birth, TB disproportionately affects non-white racial and ethnic groups statewide. Race, ethnicity, and country of birth are closely associated and highly correlated factors. The following 10 slides demonstrate how interactions between these three factors differ among various racial and ethnic populations in Minnesota. From 2004 through 2008, 91% of black TB case-patients reported in Minnesota were born outside the United States, and 9% of black TB case-patients were U.S.-born. Notably, the percentage of foreign-born persons among black TB case-patients decreased 12% from an annual average of 93% for 2004 through 2007 to 82% in 2008. Again, this decrease can be linked back to several outbreaks that occurred during 2008, as well as the slowing of refugees to Minnesota. Slide 11: Asian Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008
Slide 11: Asian Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008. Similarly, 94% of Asian TB case-patients reported in Minnesota from 2004 through 2008 were foreign-born, ranging from 87% in 2004 to 100% in 2005. Slide 12: White (Non-Hispanic) Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008
Slide 12: White (Non-Hispanic) Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008. In contrast to the predominance of foreign-born persons among black and Asian TB cases reported in Minnesota during this period, the majority (77%) of non-Hispanic white TB case-patients reported in Minnesota from 2004 through 2008 were U.S.-born persons, with only 23% of non-Hispanic white TB case-patients born outside the United States. Furthermore, the proportion of foreign-born, non-Hispanic, white TB case-patients declined quite steadily during this 5-year period, from 33% in 2004 and 2005, to 7% in 2007, and 13% in 2008. Slide 13: Hispanic/Latino Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008
Slide 13: Hispanic/Latino Tuberculosis Cases by Place of Birth, Minnesota, 2004-2008. Similar to the epidemiology of TB among blacks and Asians in Minnesota, the majority (77%) of Hispanic or Latino TB case-patients reported in Minnesota from 2004 through 2008 were born outside the United States. The annual percentage of U.S.-born Hispanic or Latino TB case-patients was highly variable during this period, ranging from 4% in 2004 to nearly half (47%) in 2008. This increase in U.S.-born Hispanic or Latino case-patients can be traced back to an outbreak of TB in 2008 which involved a Hispanic/Latino community with U.S.-born children of Hispanic/Latino decent. Slide 14: Tuberculosis Cases Born in East Asia/Pacific by Country of Birth, Minnesota, 2004-2008
Slide 14: Tuberculosis Cases Born in East Asia/Pacific by Country of Birth, Minnesota, 2004-2008. Within the tremendous ethnic diversity among foreign-born TB cases reported in Minnesota, certain countries of birth are predominant among these patients. The next six slides describe, in detail, the ethnic origins of foreign-born TB case-patients reported in Minnesota, by six large geographic regions of the world. Of TB cases reported in Minnesota from 2004 through 2008 among persons born in East Asian or Pacific countries, the largest proportion (43%) originated from China or Tibet, followed by 24% from the Philippines, 12% from South Korea, and 10% from Nepal. Three other countries of birth (Bangladesh, Japan and Taiwan) represented the remaining six (12%) case-patients. Slide 15: Tuberculosis Cases Born in Eastern Europe by Country of Birth, Minnesota, 2004-2008
Slide 15: Tuberculosis Cases Born in Eastern Europe by Country of Birth, Minnesota, 2004-2008. Among the relatively few (i.e., 14) TB cases reported in Minnesota from 2004 through 2008 among persons from Eastern European countries, the predominant country of birth was Poland (21%), followed equally by Bosnia/Herzegovina, Russia, and Ukraine (14% each). Five other countries represented one TB case-patient each. Slide 16: Tuberculosis Cases Born in Latin America/Caribbean by Country of Birth, Minnesota, 2004-2008
Slide 16: Tuberculosis Cases Born in Latin America/Caribbean by Country of Birth, Minnesota, 2004-2008. Many different countries of birth were represented among the foreign-born Hispanic or Latino TB case-patients reported in Minnesota from 2004 through 2008 and who originated from Latin America or the Caribbean. The majority (61%) of these patients were born in Mexico; an additional 14% were born in Guatemala, and 12% were born in Ecuador. The remaining 13 (14%) Hispanic or Latino TB case-patients were born in six different countries. Slide 17: Tuberculosis Cases Born in North Africa/Middle East by Country of Birth, Minnesota, 2004-2008
Slide 17: Tuberculosis Cases Born in North Africa/Middle East by Country of Birth, Minnesota, 2004-2008. From 2004 to 2008, only six TB cases were reported in Minnesota among persons born in the Middle East or North Africa, including two (33%) case-patients born in Morocco and one (17%) case-patient each born in Egypt, Kuwait, Oman, and Turkey. Slide 18: Tuberculosis Cases Born in South/Southeast Asia by Country of Birth, Minnesota, 2004-2008
Slide 18: Tuberculosis Cases Born in South/Southeast Asia by Country of Birth, Minnesota, 2004-2008. The 176 TB case-patients reported in Minnesota from 2004 through 2008 who were born in South or Southeast Asia included 26% born in Vietnam, 24% born in India, 23% born in Laos, 11% born in Cambodia, 10% born in Thailand, and 3% born in Burma. Three other countries of birth represented the remaining five (3%) case-patients. Slide 19: Tuberculosis Cases Born in Sub-Saharan Africa by Country of Birth, Minnesota, 2004-2008
Slide 19: Tuberculosis Cases Born in Sub-Saharan Africa by Country of Birth, Minnesota, 2004-2008. Among the 524 TB case-patients reported in Minnesota from 2004 through 2008 and who were born in sub-Saharan Africa, the majority (58%) were born in Somalia, followed by 21% who were born in Ethiopia, 8% born in Liberia, and 6% born in Kenya. Fourteen other countries represented the remaining 37 (7%) of these case-patients. Slide 20: Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2004-2008
Slide 20: Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2004-2008. Tuberculosis disease most commonly affects the lungs, although almost any site of the body can be affected. For reasons that are not yet understood despite extensive study, extrapulmonary TB occurs more frequently among foreign-born persons with TB disease than among U.S.-born TB case-patients. Consequently, due to the large proportion of TB cases in Minnesota that occur among foreign-born persons, extrapulmonary TB is very common in Minnesota. More than half (53%) of foreign-born TB case-patients reported in Minnesota from 2004 through 2008 had an extrapulmonary site of disease; in contrast, only 37% of U.S.-born TB case-patients had extrapulmonary involvement. This slide illustrates the need, especially in Minnesota, for clinicians to have a high index of suspicion for TB, particularly for foreign-born patients, even when the patient does not present with a cough or other common symptoms of pulmonary TB. Slide 21: Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2004-2008 NOTE: THIS SLIDE PRESENTS THE SAME DATA AS SLIDE #20, BUT IN GRAPHICAL FORMAT. Slide 21: Tuberculosis Cases by Site of Disease and Place of Birth, Minnesota, 2004-2008 (in graphical format). Tuberculosis disease most commonly affects the lungs, although almost any site of the body can be affected. For reasons that are not yet understood despite extensive study, extrapulmonary TB occurs more frequently among foreign-born persons with TB disease than among U.S.-born TB case-patients. Consequently, due to the large proportion of TB cases in Minnesota that occur among foreign-born persons, extrapulmonary TB is very common in Minnesota. More than half (53%) of foreign-born TB case-patients reported in Minnesota from 2004 through 2008 had an extrapulmonary site of disease; in contrast, only 37% of U.S.-born TB case-patients had extrapulmonary involvement. This slide illustrates the need, especially in Minnesota, for clinicians to have a high index of suspicion for TB, particularly for foreign-born patients, even when the patient does not present with a cough or other common symptoms of pulmonary TB. Slide 22: Extrapulmonary* Tuberculosis Cases by Site of Disease, Minnesota, 2004-2008
Slide 22: Extrapulmonary* Tuberculosis Cases by Site of Disease, Minnesota, 2004-2008. Among extrapulmonary TB case-patients reported in Minnesota from 2004 through 2008, the majority (53%) had lymphatic disease. Pleural, peritoneal, and bone/joint TB affected 11%, 8%, and 8% of extrapulmonary TB case-patients, respectively. Less than 5% of extrapulmonary TB case-patients each had meningeal, genito-urinary, or miliary sites of disease. Sixty-six (12%) case-patients had extrapulmonary sites of disease that were classified as "other" or did not fall into any of the aforementioned categories. *Includes cases with concurrent pulmonary disease; only extrapulmonary sites are listed. Slide 23: Cases of Drug-Resistant Tuberculosis by Place of Birth and Year, Minnesota, 2004-2008
Slide 23: Cases of Drug-Resistant Tuberculosis by Place of Birth and Year, Minnesota, 2004-2008. The prevalence of drug resistance among culture-confirmed TB cases reported among foreign-born persons in Minnesota from 2004 through 2008 varied from year to year, ranging from 10% in 2005 to 19% in 2008, with 15% of cases reported overall having resistance to at least one first-line TB medication. The prevalence of drug resistance among culture-confirmed TB cases reported among U.S.-born persons increased steadily, from 5% in 2004 to 17% in 2007, but dropped to 3% in 2008. Overall during this period, drug resistance was approximately 1.6 times more common among foreign-born TB case-patients than among U.S.-born case-patients. Slide 24: Tuberculosis Cases by Drug Susceptibility Patterns and Place of Birth, Minnesota, 2004-2008
Slide 24: Tuberculosis Cases by Drug Susceptibility Patterns and Place of Birth, Minnesota, 2004-2008. Among culture-confirmed TB cases reported in Minnesota from 2004 through 2008, foreign-born case-patients were approximately 1.6 times more likely than U.S.-born case-patients to be resistant to any first-line anti-TB drug and 1.8 times more likely than U.S.-born case-patients to be resistant to isoniazid, in particular. Although the reported prevalence of multidrug-resistant TB among U.S.-born case-patients exceeded that among foreign-born case-patients, many of the U.S.-born multidrug-resistant TB case-patients either had lived extensively outside the U.S., or resided in a household with foreign-born persons. These cases also had several other TB risk factors such as history of drug/alcohol use and homelessness. Slide 25: Foreign-Born Drug-Resistant* Tuberculosis Cases by Region of Birth, Minnesota, 2004-2008
Slide 25: Foreign-Born Drug-Resistant* Tuberculosis Cases by Region of Birth, Minnesota, 2004-2008. Among 97 foreign-born, drug-resistant TB case-patients reported in Minnesota from 2004 through 2008, the majority (45%) were born in sub-Saharan Africa, followed by 37% born in South/Southeast Asia, 12% born in Latin America or the Caribbean, and 5% born in East Asia or Pacific countries. When compared with the proportions at which these regions of birth were represented among all foreign-born TB case-patients reported in Minnesota during this period, data in this slide indicate that persons born in South/Southeast Asia were over-represented and those born in sub-Saharan Africa were under-represented among drug-resistant TB cases statewide. *Resistant to at least one first-line anti-TB drug [i.e., isoniazid (INH), rifampin, pyrazinamide (PZA), or ethambutol] Slide 26: Foreign-Born Tuberculosis Cases by Visa Status Upon Arrival in the U.S., Minnesota, 2004-2008
Slide 26: Foreign-Born Tuberculosis Cases by Visa Status Upon Arrival in the U.S., Minnesota, 2004-2008. Persons who arrive in the United States as refugees or other immigrants are screened prior to immigration for conditions of public health significance, including certain communicable diseases such as pulmonary TB disease. The next four slides present data that pertain to the percentages of foreign-born TB case-patients reported in Minnesota from 2004 through 2008 who received such screening prior to their arrival in the U.S. and the documented results of that screening. Over half (52%) of foreign-born TB case-patients reported in Minnesota from 2004 through 2008 initially arrived in the U.S. as refugees, and more than one quarter (29%) arrived as other types of immigrants. Fourteen percent of foreign-born TB case-patients arrived with other non-immigrant visa classifications, including visitors, tourists, and students. The patients' visa classifications were unknown to the patients' health care providers or local public health nurses for only 5% of foreign-born TB case-patients. Therefore, more than 80% of foreign-born TB case-patients reported in Minnesota initially arrived in the U.S. as refugees or other immigrants who received screening for TB prior to immigration. Slide 27: "TB Class" Notifications* Among Foreign-Born Tuberculosis Cases Who Arrived in the U.S. as Immigrants/Refugees Within 1 Year Prior to Diagnosis, Minnesota, 2004-2008
Slide 27: "TB Class" Notifications* Among Foreign-Born Tuberculosis Cases Who Arrived in the U.S. as Immigrants/Refugees Within 1 Year Prior to Diagnosis, Minnesota, 2004-2008. Immigrants and refugees undergo a medical evaluation, including TB screening, overseas prior to coming to the United States. Revised technical instructions for these pre-immigration medical examinations are being implemented worldwide. Individuals with TB-related conditions are given a TB Class designation. TB Classifications are as follows:
For patients who are assigned a TB Class condition, the CDC notifies the state public health department where the patient is expected to arrive. State and local public health professionals collaborate to ensure that these individuals are referred to a local health care provider for comprehensive TB evaluation and treatment, as indicated. Among foreign-born TB case-patients who were diagnosed within 1 year after arrival in the U.S., 13% had Class B1 TB designations. This strongly suggests that clinicians cannot rely solely on the results of pre-immigration medical examinations performed overseas to identify TB disease among foreign-born persons. Clinicians should have a high index of suspicion for TB in any foreign-born patient originating from a region where TB is prevalent and who presents with signs or symptoms consistent with active TB disease. The outcomes of the patients' overseas medical examinations were unknown for 33% of these foreign-born TB case-patients who were diagnosed within 12 months of arrival in the U.S. This includes primarily persons who were diagnosed in Minnesota but who initially arrived in another state and whose overseas screening results are not available to the Minnesota Department of Health. *Per results of pre-immigration screening performed overseas. Slide 28: Foreign-Born Tuberculosis Cases by Interval Between Arrival in U.S. and Diagnosis of Tuberculosis, Minnesota, 2004-2008
Slide 28: Foreign-Born Tuberculosis Cases by Interval Between Arrival in U.S. and Diagnosis of Tuberculosis, Minnesota, 2004-2008. Nearly 30% of foreign-born TB case-patients reported in Minnesota from 2004 to 2008 had resided in the United States for less than 1 year when they were diagnosed with TB disease. These patients likely represent persons who acquired latent TB infection outside the U.S. and began to progress to active TB disease prior to arriving in the U.S. Although many such cases may not be preventable in the U.S., clinicians and public health professionals should strive to promptly diagnose and initiate treatment of these cases in order to minimize the length of time for which such patients are infectious and capable of transmitting TB. More than half (51%) of foreign-born TB case-patients reported during this period in Minnesota had been in the U.S. for 3 years or longer prior to being diagnosed with TB disease. These data suggest that at least half of foreign-born TB cases reported in Minnesota may be preventable by focusing on thorough domestic screening, evaluation, and treatment of latent TB infection among recently arrived refugees, immigrants, and other foreign-born persons. Slide 29: Foreign-Born Tuberculosis Cases by Status Upon Arrival and Interval Between Arrival and Diagnosis of TB, Minnesota, 2004-2008
Slide 29: Foreign-Born Tuberculosis Cases by Status Upon Arrival and Interval Between Arrival and Diagnosis of TB, Minnesota, 2004-2008. Among foreign-born TB case-patients reported in Minnesota from 2004 through 2008, data on the length of the interval between the patients' arrival in the United States and their diagnosis of TB disease varied by the patients' visa status at the time of arrival in the U.S. In particular, the percentage of patients who were diagnosed with TB within less than 1 year of arriving in the U.S. was higher among those who arrived as refugees or other immigrants (30%) than among those who arrived with other visa classifications or whose visa status was unknown (20%). In contrast, the percentage of patients who were diagnosed more than 5 years after arriving in the U.S. was higher among those with other or unknown visa classifications (45%) than among refugees and other immigrants (33%). These findings may reflect an actual difference in the pathogenesis of TB between these two groups, or the data may simply reflect the hypothesis that the longer a person resides in the U.S., the less likely that information about the person's visa status will be known by his or her health care provider. If you have questions or comments about this page, use our IDEPC Comment Form or call 651-201-5414 (TTY: 651-201-5797) for the MDH Infectious Disease Epidemiology, Prevention and Control Division. |
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Updated Wednesday, 03-Jun-2009 10:29:34 CDT
